Provider Demographics
NPI:1083612956
Name:HARGUES, KENNETH L (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:L
Last Name:HARGUES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3034
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88221-3034
Mailing Address - Country:US
Mailing Address - Phone:575-628-0700
Mailing Address - Fax:575-885-2095
Practice Address - Street 1:701 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5137
Practice Address - Country:US
Practice Address - Phone:575-628-0700
Practice Address - Fax:575-885-2095
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist